Abortion Doula Diaries: Que bueno que estas aqui

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Every shift I work at the hospital leaves me with many reflections on the experience of supporting women through abortions, the things I learn about their lives in the short time we spend together, the twisted way politics interferes with what happens there.

Every woman responds differently to the experience, brings a different level of energy, nervousness, calm.

This afternoon I’m thinking about one of the two women I supported this morning. She reminded me a lot of one of the first women I worked with. Both were emotional during the procedure, and when we talked afterwards, they explained how isolated and alone they felt. Both were Spanish-speaking immigrant women, both lived in close vicinity to extended family. Both talked about their partners, how unsupported and alone they felt as women–how they weren’t treated well. Me siento tan solita (I feel so alone) she told me this morning.

Often in the Latino community, we get stereotyped for being very family centered. Big families where everyone lives really close by, is very involved in each others lives. Often this is juxtaposed with the more American or Anglo family style–fewer kids, more distance between everyone, less involvement. Obviously these are generalizations, stereotypes, but I have felt the impact of American family culture in my own family–as a kid I remember spending much more time with cousins and Uncles and Aunts, grandparents, all of us together in summers and Christmas’s. Now as we’ve grown, this first generation of truly American children, we’ve scattered across the country, hundreds of miles from one another.

Sometimes I wonder what it would be like to be closer to everyone, to feel the warmth and stress and love of my blood relatives. Sometimes I wonder if we wouldn’t be better off, staying close, being more involved.

But then I’m reminded that it’s not always so simple, that it’s not always so black and white. Then I meet women like those I’ve met at the clinic, and I remember that family doesn’t always equal companionship. That sometimes, family relationships can be damaging, unhealthy, harmful. Both of these women hinted at abuse, neglect, mistreatment from their own family. This is how you come to feel so alone amongst many people.

The more I do this work, the more I think that most of my value as a doula in these moments is simply being a kind stranger who listens. I never feel like I’m doing very much, usually just making conversation, reassuring, holding hands and caressing shoulders. I’m a smiling face at the bedside without any other tasks than to just be present.

Today one of the women looked up at me during the procedure and smiled: Que bueno que estas aqui (How good that you are here). I responded: Mi placer (My pleasure). And it really is my pleasure, my delight that such a simple act might have an impact. Might make someone feel less alone and more resilient.

Before we parted ways she said to me Este trabajo que tu haces es muy lindo (This work that you do is very lovely).

Vermont mandates insurance coverage for licensed midwives

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Great news from Vermont:

“One of the things that’s extremely important to our families is to be able to have a choice about the way we bring Vermonters into this world,” said Gov. Peter Shumlin, D-Vermont.

Shumlin signed a bill into law Wednesday requiring Vermont insurance companies to pay for the prenatal care, deliveries and aftercare that licensed midwives provide.

Insurance coverage for midwifery is a win-win situation. It saves insurers and the state money, and parents get the care they want.

Victory for midwives in Colorado

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For the last few months I’ve been watching the situation in Colorado, where the bill allowing direct-entry midwives to practice was set to expire.

Indra Lusero and a group of consumer advocates were working hard to improve the new version of the law. They wanted to make sure that midwives were given the best opportunity to practice their trade, supported by the law.

This is a legislative situation we don’t hear much about. A lot of the news focuses on states trying to get these licensing laws established in the first place (there are currently 23 states without them on the books). But all of these laws do “sunset” at some point, and have to be renewed. It presents an opportunity to change things for the better, which is what these folks were able to do.

Indra and I spoke on the phone during the campaign. Indra became a midwifery advocate after her own home birth. This is what she had to say about why they began the campaign:

Midwives were frustrated with the current state of the law which was inacted in 1993 and hadn’t been improved in 17 years. Some of those initial compromises that had been made in that fraught time were really limiting. Some of the language was explicitly opposed to midwifery—”we’re going to regulate you but we don’t feel good about it.” Some of the scope of practice things: not being able to carry anti-hemorrhagics. Rogam, Vitamin K. And one of the bigs one that we’re fighting over this session is suturing—the ability to repair minor tears at home.

In political environments that are often very midwife unfriendly, these battles can be particularly challenging. Midwives are afraid if they push to hard, they might lose altogether and no longer be able to practice in the state. So often what results is compromise laws that can severely limit the midwives ability to practice as they are trained to do.

Indra’s group though, presented a different advocacy effort–that of consumers, not the midwives themselves. Their stake in the fight is different, and can be received by elected officials in new ways.

In the end it was a big success, and the new version of the bill has passed through the State Legislature with little opposition, to be signed into law by the Governor soon. They weren’t able to secure suturing privileges, but there is a possibility that could be allowed through other mechanisms.

Here are a few of the changes they were able to achieve:

  • Registered CPMs can now be simultaneously licensed as nurses (and vice versa). This was prohibited in the original law.
  • Registered CPMs can now obtain and use these drugs: Vitamin K, Rogam, antihemorrhagic drugs, and eye prohylaxis.
  • The language that spoke negatively of midwifery was removed.

Those are just a few highlights! You can read all the nitty gritty details here. A big congrats to the folks in Colorado who worked on this bill.

Help a radical doula with her dissertation research

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An awesome doula and activist who I had the pleasure of meeting last year, Monica Brasile, is working on her doctoral research about the doula community. She’s looking for folks to take 20 minutes to fill out her survey.

I hope you will participate in my study about doulas. I am a practicing childbirth educator and doula, midwifery activist, and graduate student in the department of Gender, Women’s, and Sexuality Studies at the University of Iowa.

I am currently doing research for my doctoral dissertation about the role of doulas in the culture of the childbirth and reproductive justice movements in the U.S. I invite you to take my survey to help bring attention to the exciting work that doulas are involved in! All doulas are invited to participate.

I am particularly interested in the work of those who identify as radical or full spectrum doulas, and those doing community-based or volunteer work.

Link to survey here!

Are teen pregnancy prevention messages harming young parents?

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In my latest article for Colorlines I examine what impact teen pregnancy prevent messages may be having on teens who end up parenting.

An excerpt

Teen pregnancy prevention initiatives are often based on the premise that teen parenting is an indisputably bad thing and should be avoided at all costs. And as a consequence, teen moms are constantly presented as failures and victims. “I love my life. I’m not gonna mess it up with a pregnancy,” says a teenager at the end of a video on the National Campaign to Prevent Teen and Unwanted Pregnancy’s website, Stayteen.org.

Prevention advocates point to the fact that teen parents have higher incidence of the range of problems public health works so hard to end. In a document targeting parents of teens, the National Campaign explains:

“Compared to women who delay childbearing, teen mothers are less likely to complete high school and more likely to end up on welfare. The children of teen mothers are at significantly increased risk of low birth-weight and prematurity, mental retardation, poverty, growing up without a father, welfare dependency, poor school performance, insufficient health care, inadequate parenting, and abuse and neglect.”

It’s a compelling formula—simply stop teen girls from having kids, and these disparities disappear. But the question that remains is what’s really behind these negative outcomes? Is young pregnancy and parenting the cause, or it a correlation with other risk factors, like socio-economic status and race, that recur at all ages?

I think it’s an important question because the Obama Administration has invested millions of dollars in these programs, while young parents are often not getting the support and services they need.

Read the whole thing here.

Celebrating Mama’s Day

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This year I’m working with the folks at the Strong Families Initiative on their Mama’s Day campaign. Mama’s Day is about turning mother’s day around and focusing on the moms in our communities who often get left out of the celebrations, particularly young moms, immigrant moms, queer moms and low-income moms. Not only do these mamas often not get love on mother’s day–in today’s political climate, they get scapegoated and targeted.

As doulas, our work is just that: to provide love and support to all the mamas we work with, regardless of who they are or what phase of pregnancy they are in. That’s why I support this campaign.

We’ve also got a ton of blog posts from these Mama’s here, as well as some beautiful images like the one below to show your support to the mamas in your life.

Babies need love, Moms do too. Tell an immigrant mom, "I stand with you."

Check out the campaign on facebook and twitter to learn more.

In search of: Doula of color in the Twin Cities, MN

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See the request below and contact them directly if you are a good fit.

We are in search of a DONA-certified Doula in the Twin Cities, MN who is familiar with/ connected to indigenous birthing and parenting knowledge/ practices from throughout Africa (preferably West Africa) OR South Asia (preferably South India). My partner is English-speaking but grew up throughout the African continent. He would benefit from working with someone who understands his concerns and the disconnects between between (West) African and U.S. conceptualizations of perinatal health and wellness for both mothers and babies. I am South Indian but, having grown up in the U.S., am more accustomed to translating/ negotiating between the two worldviews. At a minimum, we would like to work with a woman of color or indigenous woman who honors the knowledge/ practice of traditional birthing attendants. We are due in late August and are currently planning a hospital birth (water labor and water birth if the hospital completes its setup in time) with a midwife.

Please contact me at shan0133@umn.edu with details about your background/ availability/ expectations/ etc. Thanks!

Interview with Ina May Gaskin about women of color and birth

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I had the unique pleasure of interviewing midwife and birth activist Ina May Gaskin (via email) for my latest Colorlines feature.

Ina May graciously allowed me to post the full text of our interview since only a few snippets made it into the Colorlines piece. She had a lot of wisdom about this issue (not surprisingly!). It really is worth the read–Ina May displays a really comprehensive understanding of the issues facing women of color when it comes to out-of-hospital birth care.

Here’s Ina May:

RD: You mention briefly in Birth Matters that when obstetricians were trying to bring birth to the hospital (and learn how to care for birth), one doctor in Chicago paid immigrant women to give birth there. I’ve also understood that initially, particularly black women weren’t allowed access to hospital birth because of segregation/racism and class issues as well.

IM: That’s true. In general, low-income women in urban areas were initially brought into hospitals so that doctors in training could practice on them. That how they “paid” for their care.

RD: Can you tell me a little more about the history of particularly women of color in the US when it came to birthing in the hospital? Did they have a different experience than white women in terms of when they made the transition from home birth to hospital birth?

IM: Yes. For the most part, women of color who lived in the rural south didn’t go into the hospital until the 1970s and 80s. Alabama, Mississippi, Arkansas, Florida, and Georgia still had midwives who assisted women giving birth at home right through the 1970s. When doctors could count on Medicaid reimbursement for the first time, that situation quickly changed, and the midwives who were so needed before were forced to retire. Farther north, the pattern was somewhat different, because midwifery was outlawed in many states. Everyone was pushed into the hospital when this happened, regardless of the color of their skin. Women of color and poor white women were both used as teaching material in the teaching hospitals throughout the country. For this reason, the shift from home birth to hospital birth took place much earlier among urban women of color than it did for those in rural areas of the south.

Continue reading →

Maternal mortality is on the rise in the US. What can we do about it?

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My latest article is up at Colorlines, about the issue of maternal mortality in the United States, particularly for women of color.

The United States spending more money per capita than any other country in the world on health care, but we rank behind 40 other countries when it comes to maternal mortality. Ina May Gaskin, in her new book (review to come!) says that women today are two times more likely to die from childbirth than their mothers were.

A report recently released by the New York City Department of Health examining maternal mortality in the city between 2001 and 2005 found striking disparities for women like Eady: black, non-Hispanic women were more than seven times more likely to die from pregnancy-related causes than white, non-Hispanic women. Such disparities recur nationally. In a March 2010 report entitled “Deadly Deliveries,” Amnesty International explained, “African-American women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years.”

But as Rita Henley Jensen explains, the New York report also points to something more than the usual indicators for maternal mortality—poverty, lack of prenatal care and preexisting conditions. Maternal mortality is not just restricted to women of color; we’re actually seeing a rise in maternal and fetal mortality rates overall. California has reported a near tripling of their maternal mortality rate in just the 10 years between 1996 and 2006. The U.S. ranks behind 40 other countries in terms of maternal mortality rates, despite spending the most money per capita on health care.

So how have we created the world’s most expensive maternity care system while still putting women and babies at risk? The answer lies in two of our culture’s biggest influences: money and technology. And now, even as Republican legislators aim to gut the Medicaid program that millions of women depend upon, a movement is growing to make maternity care both cheaper and safer by giving poor women greater access to home births.

I have to say I didn’t like the title of the piece (determined by the editors) because it isn’t just about home birth–it’s about normalizing midwifery care, and particularly expanding access to out of hospital birth, which includes birth centers as well as hospitals. It also includes midwife-provided prenatal care, even if women eventually birth in hospitals.

Home birth is still a dirty word in this country. It’s considered backwards, it’s considered unsafe, it’s considered what someone does when they have no option. This ideology is part of a calculated campaign on behalf of doctors to convince women to give birth with them in the hospital, something that actually killed more women than home births in the initial decades of hospital birth.

Home birth isn’t the problem, and never has been. The problem is making sure all women have access to skilled attendants who know how to care for pregnant women, know how to detect problems, know when to transport to a hospital or when someone might need an obstetrician–someone who is trained specifically to deal with the minority of cases that need specialized medical attention.

Women in the United States are dying in spite of having access to hospital-based maternity care (98%).

That means that women in the US are dying because of hospital-based maternity care.

Either that care is inadequate (like Akira Eady, who I wrote about in the piece, who died from a complication after being released from the hospital postpartum ), or it’s simply too reliant on interventions and surgeries that are harmful. A 33% c-section rate is simply too high. Mothers are dying because they are getting too many surgeries, too many interventions, too many inductions.

We know clearly what isn’t working. The status quo. The 98% hospital birth, the only 9% midwifery care. My article tries to explain how we got here, and what might just help us go in a different direction–back toward patient-centered care that minimizes the use of technology rather than emphasizing it. That only employs tools like c-section when they are really necessary, not just when they are convenient or used to preemptively prevent litigation.

I can’t say definitively that a move back to midwifery care (or home birth) would eliminate disparities. It probably wouldn’t–because racism and classism still exist and still effect our health outcomes. But out-of-hospital midwifery care has some pretty amazing successes both in the US and abroad in terms of reducing maternal mortality. Let’s give it a shot–see if we might not be able to improve these statistics instead of seeing them get worse and worse and worse.

The NYC Doula Project is recruiting!

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The Doula Project, based in New York City, is recruiting it’s next round of doulas.

I helped to found The Doula Project a few years back alongside Mary Mahoney and Lauren Mitchell. I left NYC before the project really got going and came back to it just this fall. It’s an absolutely amazing crew of folks working to provide doula care to people across the spectrum of pregnancy. I work, through the project, providing support to women having abortions in a public hospital.

I cannot say enough good things about this project!

If you are in NYC you should definitely apply.

I am not part of the application vetting process, but know that you don’t need to have previous doula experience to apply. Folks are trained to do the abortion doula work by the project itself. Birth doula training is only necessary if you want to do the birth components of the project, but it’s not a requirement.

Full details and application here.